Medulloblastoma

What Causes a Medulloblastoma?

In most cases, there is no identified cause. There is no evidence to suggest that any environmental factors cause this type of tumor. In a small proportion of cases, certain genetic conditions called cancer predisposition syndromes can increase risk of developing medulloblastoma, but the majority of cases are not passed down to offspring. Rather, researchers believe that the most common cause is something is absent during normal development. Specifically, cells of the brain and spinal cord grow and divide as the body develops. During this cell division process, cells need to replicate their genetic material. Errors can take place during this process, leading to mutations (changes in the structure of the genes), which may allow cells to grow into tumors. These errors generally occur randomly and cannot be prevented.

What Are the Signs and Symptoms of a Medulloblastoma?

Your child’s symptoms may vary depending on the location and extent of the tumor and whether the tumor has spread to other areas. Symptoms that your child might experience include:

• Headaches (often worse in the morning) accompanied by nausea and vomiting
• difficulty with balance and coordination
• problems with motor skills, such as writing and walking

How Is a Medulloblastoma Diagnosed?

Your child's healthcare provider will ask about your child's health history and symptoms. The provider will do a physical exam and a neurological exam. They will test your child’s reflexes, muscle strength, eye and mouth movement and coordination. Your child's healthcare provider may refer your child to a cancer specialist (oncologist). Your child may need additional tests, including:

• CT Scan - A CT scan uses a series of X-rays and a computer to take pictures of the head or body. CT scans are very quick imaging, usually no more than a few minutes of scanning (though preparation may take longer).
• MRI - An MRI uses large magnets, radio waves and a computer to make detailed pictures of the body. Contrast dye may be injected into your child's vein to make the tumor more visible. MRIs are very detailed imaging (provide much more information about the tumor), so take longer to perform (often 1-2 hours).
• Biopsy - Tumor cells are removed during surgery and sent to a lab for testing. This is done to find out the type of tumor (to finalize the tumor diagnosis) to determine how best to treat it and to understand how aggressive it is.
• Lumbar Puncture (or Spinal Tap) - Spinal fluid is removed (using a small needle injected into the lower back while the patient is asleep) and sent to a lab for testing. This is done to evaluate for the presence of tumor cells that have spread to the spinal fluid.

How Is a Medulloblastoma Treated?

Treatment for medulloblastomas will be individualized based on your child’s age, whether the tumor has spread, and certain features of the tumor. Your child’s treatment may include some or all of the following:

• Surgery - This is done to remove part or all of the tumor. More surgery may be needed over time if the tumor grows back. Surgery may be followed by chemotherapy or radiation therapy.
• Chemotherapy - These are medicines that kill cancer cells. One or more medicines may be given. Medicines may be oral or given through an IV or central line.
• Radiation Therapy - These are high-energy X-rays or other types of radiation. They are used to kill cancer cells or stop them from growing. 
• Clinical Trials - A clinical trial is a way to test new treatments for cancer. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child. Many new treatments are only available in clinical trials.
• Supportive Care - Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, nausea and vomiting. This an important part of cancer care.

Your child may have short- and long-term problems from the tumor or from treatment. These may include:

• Damage to the brain or nervous system that causes problems with coordination, muscle strength, speech or eyesight
• Problems after surgery, such as infection, bleeding and problems with general anesthesia
• Infection or increased risk of bleeding from chemotherapy
• Delayed growth and development
• Learning problems
• Problems with reproduction (infertility)
• Return of the cancer (recurrence)
• Increased risk for other cancers later in life

Talk with the doctor about what you should watch for and what can be done to help prevent complications.

Survivorship – Outcomes and Life After Medulloblastoma Treatment

Improving the quality of life of survivors of brain and spine tumors is an area of much ongoing research and continued progress. Some patients have little to no long-term problems from their tumor or treatment, whereas other patients experience more significant side effects. All patients will continue to be followed by the oncology team after finishing treatment to ensure they are doing well and to offer appropriate resources, therapies, and subspecialty team services as needed. Patients will also continue to get surveillance imaging (MRIs) to ensure their tumor does not grow back; as the time from end of treatment increases, these scans will be spaced further apart.

Why Choose Nationwide Children’s Hospital?

The Neuro-Oncology Program at Nationwide Children’s Hospital offers clinical excellence in treating children, adolescents, and young adults with brain and spine tumors. Patients and their families will be supported by a multi-disciplinary team of providers, all dedicated to ensuring that the patient has the best possible outcomes. Depending on the specific tumor diagnosis and treatment plan, the patient and their family will be cared for by oncologists, neurosurgeons, radiation oncologists, clinical psychologists, rehabilitation medicine doctors, neurologists, endocrinologists, ophthalmologists, therapists (physical, occupational, speech, art, music), social workers, dieticians, and/or pharmacists. These team-members all work closely together with one another and the family to provide the best care for the patient.

Nationwide Children’s Hospital is also a national leader in oncology research and clinical trials. There are many ongoing research studies aimed at improving outcomes for children and young adults with brain/spine tumors—understanding why these tumors develop and how to appropriately target them. We are members of all major pediatric brain tumor clinical trial consortia including Pediatric Brain Tumor Consortium (PBTC), Collaborative Network of Neuro-oncology Clinical Trials (CONNECT), Pacific Neuro-oncology Consortium (PNOC) and the Children’s Oncology Group (COG). We have many open clinical trials testing new drugs in difficult-to-treat tumors.